CT angiograms of the neck in strangulation victims: incidence of positive findings at a level one trauma center over a 7
- PDF / 2,404,902 Bytes
- 8 Pages / 595.276 x 790.866 pts Page_size
- 114 Downloads / 160 Views
ORIGINAL ARTICLE
CT angiograms of the neck in strangulation victims: incidence of positive findings at a level one trauma center over a 7-year period Omar Safi Zuberi 1
&
Trent Dixon 1 & Alexander Richardson 1 & Ashish Gandhe 1 & Mohiuddin Hadi 1 & Jonathan Joshi 1
Received: 1 October 2018 / Accepted: 3 April 2019 # American Society of Emergency Radiology 2019
Abstract Purpose To determine the incidence of acute findings diagnosed with computed tomography angiography (CTA) of the neck among emergency department patients presenting with strangulation injury. Method and materials This institutional review board-approved, HIPAA-compliant retrospective review was performed at our academic urban level 1 trauma center. The PACS database was queried for all consecutive patients who had CTAs of the neck performed for the exam indication of strangulation between January 1, 2009, and April 30, 2016, resulting in 142 included patients. Analysis of the individual cases was then performed, recording any positive results, with clinical findings classified using, when possible, standardized terminology found in the literature. Frequency of acute injury in the CTA neck examinations was determined with the calculation of 95% confidence interval (CI) and positive clinical findings were evaluated by calculation of prevalence. Additionally, two board certified radiologists with training in neuroradiology assessed the cases for vascular injury. Results There were 142 patients who met inclusion criteria (average age, 32.6 years) and 116 (81.7%) patients were female. CTA of the neck revealed 21 patients to have acute injuries (15.5%, 95% CI 9.5, 21.4) including 6 initially reported vascular injuries (4.2%, 95% CI 0.9, 7.5). Although neck pain (73, 51.4%), loss of consciousness (67, 47.2%), and headache (31, 21.8%) were frequently reported in the ROS, their predictive value of vascular injury was weak (4.1%, 4.5%, and 3.2%, respectively). On physical exam, redness/bruising of the neck (73, 51.4%) and neck tenderness (47, 33.1%) were both the most common and had the highest prevalence (19.2% and 12.8%, respectively), however, when selecting for vascular injuries alone were found to have low predictive yield (vascular injury 4.1% and 2.1%, respectively). The above statistics were based on the initial radiologist report and Emergency Department findings. After retrospective review, 3 Grade 1 BIFFL vascular injuries were identified (2.1%), with one false negative case (0.7%). Conclusion Performing CTA of the neck after acute strangulation injury rarely identifies clinically significant findings, with vascular injuries proving exceedingly rare. As positive vascular injury could not be clinically predicted by history and physical examination, prospective validation of a clinical prediction rule in this population is warranted. Keywords CTA . Angiogram . Strangulation . Strangled . Vascular injury . Trauma
Introduction Blunt cerebrovascular injuries (BCVIs) are typically described as acute injuries of the carotid or vertebral arteries from
Data Loading...
